Symptom targeted intervention

Symptom targeted intervention (STI) is a clinical program being used in medical settings to help patients who struggle with symptoms of depression or anxiety or adherence to treatment plans but who are not interested in receiving outpatient mental health treatment. STI is an individualized therapeutic model and clinical program that teaches patients brief, effective ways to cope with difficult thoughts, feelings, and behaviors using evidence-based interventions. Its individualized engagement process employs techniques from solution-focused therapy, using a Rogerian, patient-centered philosophy. This engagement process ensures that even challenging, at-risk, and non-adherent patients are able to participate. Symptom targeted intervention (STI) is a clinical program being used in medical settings to help patients who struggle with symptoms of depression or anxiety or adherence to treatment plans but who are not interested in receiving outpatient mental health treatment. STI is an individualized therapeutic model and clinical program that teaches patients brief, effective ways to cope with difficult thoughts, feelings, and behaviors using evidence-based interventions. Its individualized engagement process employs techniques from solution-focused therapy, using a Rogerian, patient-centered philosophy. This engagement process ensures that even challenging, at-risk, and non-adherent patients are able to participate. Social workers and other mental health practitioners and medical professionals use STI to assist patients with a number of specific concerns, from sleep and stress to pain management, relationships and mood management. STI's coping tools are cognitive behavioral therapy and mindfulness interventions that have been condensed and modified to make them user friendly and effective in brief sessions. After meeting with the clinician, the patient takes charge, performing interventions at home through assignments that extend and reinforce learning. Using STI, the clinician helps the patient identify the most problematic symptom of the depression (such as depressed mood, insomnia, anxiety, rumination, irritability, negative thinking, social isolation), then together the clinician and patient address that symptom using STI's evidence-based selection of brief cognitive, behavioral, and mindfulness techniques. The emphasis is on keeping interactions brief since mental health treatment in the primary care setting is typically time limited—although the Collaborative Care and Integrated Care models provides hope for improved and expanded mental health services in the primary care setting. As patients learn better coping skills, they become more engaged with their treatment and more adherent to doctors’ recommendations. STI also gives social workers ways to uncover their clinical strengths and tools to continue to work with resistant patients. With STI training, clinicians learn a nuanced approach to all patients, even those who resist help, since often those are the individuals who need help most. After learning STI, clinicians report that they are more likely to approach rather than avoid difficult patient situations. STI was created in 2009 by licensed clinical social worker (LCSW) Melissa McCool to give clinicians a toolkit for helping depressed patients who cannot or will not seek outpatient psychotherapy. McCool originally developed STI for patients with end-stage renal disease (ESRD). Patients with ESRD and other chronic diseases often suffer from depression and it often goes undiagnosed. Studies suggest that at least 25% of dialysis patients have clinical depression and at least 35% have symptoms that put them at risk for depression. Additionally, for a variety of reasons, patients who are suffering mentally and physically from depression often go untreated. Social workers using STI with ESRD patients have reported promising outcomes. The intellectual premise for STI is based on systems theory, which considers a system as a set of interacting and independent parts. If depression is a system consisting of various symptoms, when one of the symptoms improves, the entire trajectory of the depressive episode is transformed. In this sense, STI is related to Bowen's systemic theory and its interactional dynamics. Using STI, the patient and clinician focus on one element, or symptom, helping the patient avoid feeling overwhelmed by multiple problems. The parallel process is also in effect: Clinicians may be similarly overwhelmed by attempting to tackle multiple symptoms in their depressed patients. Also central to STI is the cognitive triangle, which illustrates how one's thoughts, feelings, and behaviors are all interconnected and dependent upon one another. If a behavior changes, thoughts and feelings change; if a thought changes, behaviors and feelings change. STI has been expanded beyond ESRD to support the many patients who are suffering from depression who receive treatment for chronic disease in outpatient clinics, hospitals, nursing homes or rehabilitation centers. Kaiser Permanente is now using STI as the main treatment modality in its Collaborative Care study.